Getting the right dose

When it comes to healthcare, “technology” — in the most general sense of the word — is the holistic, user-customizable lens that an organization’s entire clinical team needs to function at the top of their license.

It’s what healthcare organizations need to perpetuate best practice. And it’s table stakes for ensuring patient trust. Innovative technology should be easily accessible for clinical teams to further accelerate their care initiatives.

This article was written in collaboration with Premier.

Recently, healthcare improvement company Premier® formed a partnership with InsightRX, which offers a precision dosing platform that creates efficiencies to optimize the cost of and improve patient care. Premier’s member engagement manager for clinical surveillance, Daisy Jackson, BSEH, CIC, sat down with Jon Faldasz, PharmD, BCPS and head of clinical applications for InsightRX to discuss all things precision dosing.

Daisy Jackson: Why is precision dosing important?

Jon Faldasz: Precision dosing is all about getting every patient the right dose. Yes, I realize that this seems like an incredibly simple task. But, the fact is that people come in all shapes and sizes. When pharmaceutical companies develop drugs, they identify a variability in doses that work for different people. However, when it comes time to release them, they often just recommend one or two doses for everyone.

When drugs are brought to market, we know the approved doses will fail in some people and be toxic in others. Historically we have accepted this as part of the reality of practicing medicine, we just didn’t have the technology to do much more than that. But now technology and healthcare are catching up, and we are finally realizing the capability and potential of offering individualized, precision dosing. We can find a dose for each person that will be effective and nontoxic.

This is more than an important development. It is revolutionary.

DJ: What challenges do clinicians deal with today?

JF: One of the most challenging feelings for a clinician to face is one of helplessness. We all want to do what is best for our patients. When we feel that we can’t provide the best care possible, especially when we know that we should be able to provide that care, it is incredibly frustrating.

This is the pain many clinicians feel today. We know that because of the one-size-fits-all approach that everyone has just accepted for so long, we will be providing suboptimal and/or toxic therapy to our patients. This is just something that clinicians have accepted as a cost of doing business.

Our historical limitations in administering therapy at proper doses meant that we would invariably fail many patients in one of two ways: either not effectively treating their condition or creating adverse effects like bone marrow suppression, renal failure, transplant graft failure and graft-versus-host disease, among others.

DJ: What does the latest science tell us?

JF: We’re at a turning point for precision dosing and science and technology supporting it. MAP-Bayesian forecasting, a mathematical tool that has been around for decades, is finally getting the attention it deserves in the world of precision medicine. Studies have continuously demonstrated that the MAPBayesian approach provides the best predictions when it comes to patient-specific dosing.

The AAC has published a study concluding that using a clinical decision support tool for therapeutic drug monitoring, coupled with MAP-Bayesian forecasting, works better at getting patients to their therapeutic targets than when clinicians do it on their own. With the breadth of data and the increasing availability of MAP-Bayesian software platforms like InsightRX, the guidelines call for using this software as the standard of care.

It seems that the world is now ready for both precision medicine and precision dosing.

DJ: What is InsightRX’s approach to precision dosing, and how is it unique?

JF: The first differentiator is the MAP-Bayesian forecasting. It enhances clinicians’ ability to interpret information — for example a drug level — by offering the context of what could be expected based on pharmacokinetic models. This is incredibly powerful and is proven to improve the ability to dose drugs correctly.

InsightRX also uses continuous learning. Today, we have a general idea of how we think patients should respond pharmacokinetically. We expect the drug to move through their body in a certain way, based on their age, size, gender, lab markers, etc. All of this is all summarized mathematically in a pharmacokinetic model.

But we know that the models aren’t perfect. That’s why we get drug levels: every patient is a little different, and the models don’t describe every person perfectly. InsightRX uses that data to improve the models themselves. It’s possible that patients will respond differently based on factors like ethnic heritage, age, disease state or genotype, among others. These factors are analyzed and used to improve the models, so that when a similar patient is presented, we are that much more likely to get the right dose the first time. This learning cycle continues in perpetuity until there is a model that describes everyone, resulting in the exact dosing for every patient from day one.

DJ: What are the main benefits of using precision dosing?

JF: As with anything in healthcare, the goal is to get patients healthy as quickly and safely as possible. When you compare InsightRX to other means of monitoring, you’re also able to achieve these goals with fewer measured drug samples, which means less phlebotomy and less pokes for your patient. In adults this can really improve patient satisfaction, but one less blood draw may prevent a baby from needing a blood transfusion later on.

DJ: Why did InsightRX choose to partner with Premier?

JF: This was a natural partnership. Premier is a wellrespected organization, committed to facilitating and advancing the ability for healthcare providers to improve patient care. By aligning with Premier, we are able to bring precision dosing to even more hospitals and health systems across the United States. Making the partnership even more exciting for us was the ability to integrate with the patient chart through Premier’s clinical surveillance solution, which is powered by TheraDoc®.

We are thrilled to be working with the fabulous team at Premier and look forward to working together for years to come.



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